Disordered eating in African American and Caucasian women: the role of ethnic identity.

The influential roles of culture and ethnic identity are frequently cited in developing disordered eating and body dissatisfaction, constituting both protective and risk factors. For African American women, strongly identifying with African American cultural beauty ideals may protect against disordered eating to lose weight, but may actually increase risk in development of disordered eating directed at weight gain, such as binge eating. This study compares African American and Caucasian women on disordered eating measures, positing that African American women show greater risk for binge eating due to the impact of ethnic identity on body dissatisfaction. Findings indicate low levels of ethnic identity represent a risk factor for African American women, increasing the likelihood of showing greater binge eating and bulimic pathology. In Caucasian women, high levels of ethnic identity constitute a risk factor, leading to higher levels of both binge eating and global eating pathology. Implications for prevention and treatment are discussed.

Residential treatment for eating disorders.

OBJECTIVE: The current study describes residential treatment for eating disorders in the United States. METHOD: A national study involving 22 residential eating disorder treatment programs was conducted using a survey to determine treatment program descriptions and trends. Data from 19 respondents, representing 86% of all residential treatment programs in the United States, were examined. RESULTS: Residential treatment options for individuals with anorexia nervosa and bulimia nervosa are becoming increasingly more common. A wide variety of techniques and methods are employed in the treatment of individuals with eating disorders in residential treatment programs. The average length of stay in treatment was 83 days, with an average cost per day of 956 US dollars. CONCLUSION: The residential treatment of individuals with eating disorders is a growing, variable, and largely unregulated enterprise. Future research is needed to focus on quantifying treatment program effectiveness in the residential treatment of individuals with eating disorders.

Pharmacotherapy of bulimia nervosa and binge eating disorder: longer-term outcomes.

The longer-term effects of antidepressant medication, with and without the addition of psychotherapy, for the treatment of bulimia nervosa and binge eating disorder are reviewed. The use of a single antidepressant agent results in recovery of about 25 percent of patients entering treatment; continued treatment is accompanied by relapse in about one-third of these patients. Substituting one or more antidepressants for the initial agent in patients who fail to improve or cannot tolerate side effects improves long-term maintenance. Adding cognitive-behavioral therapy (CBT) may prevent relapse once medication is discontinued, and the combination of CBT and antidepressant treatment is more effective than a single medication. There is also evidence that antidepressant treatment combined with CBT is more effective than placebo plus CBT. The problem of how to sequence medication and CBT has not been resolved, although a recent study demonstrating that pharmacotherapy is more cost-effective than CBT suggests that treatment might begin with medication.

Future directions in obesity and eating disorders.

The purpose of this article is to explore future directions in the treatment of obesity and eating disorders. After briefly reviewing the costs of eating disorders, in terms of morbidity, mortality, and economics, we provide suggestions for future research and treatment. We first focus on changes that should be considered to improve etiological and outcome research, with the idea that a better understanding of etiological factors will lead to better interventions. We then examine promising treatment approaches, public health initiatives, and the importance of focusing on health and self-acceptance as valid treatment outcomes.

Comparing the cost effectiveness of psychiatric treatments: bulimia nervosa.

We conducted an exploratory post hoc study that compared the cost effectiveness of five treatments for bulimia nervosa: 15 weeks of cognitive behavioral therapy (CB) followed by three monthly sessions, 16 weeks (Med16) and 24 weeks (Med24) of desipramine (< or = 300 mg/day), and CB combined with desipramine for those durations (Combo16 and Combo24). We illustrate how a treatment's cost effectiveness varies according to when evaluation is done and how effectiveness and cost are defined. At 32 weeks, Med16 appears the most cost-effective treatment, and Combo16 appears the least. At 1 year, Med24 appears the most cost-effective treatment, and Combo16 appears the least. Using this post hoc analysis as an example, we discuss the pitfalls and limitations of cost-effectiveness analysis of psychiatric treatments.